HCPCS replacement codes, effective Oct. 1, 2021, established

J1305 replaces J3490, J3590 and C9079 when billing for Evkeeza (evinacumab-dgnb)

Effective Oct. 1, 2021, the Centers for Medicare and Medicaid Services has established a permanent procedure code for specialty medical drug Evkeeza™ (evinacumab-dgnb).

Services can continue to be reported with J3490, J3590 and C9079 through Sept. 30, 2021. All services performed on and after Oct. 1, 2021, must be reported with J1305.

Prior authorization is required by the Medical Benefit Drug Prior Authorization program for Evkeeza (evinacumab-dgnb), procedure code J1305, for all groups unless they opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this procedure requires manual review.

J1448 replaces J3490, J3590 and C9078 when billing for Cosela (trilaciclib)

Effective Oct. 1, 2021, CMS has established a permanent procedure code for specialty medical drug Cosela™ (trilaciclib dihydrochloride).

Services can continue to be reported with J3490, J3590 and C9078 through Sept. 30, 2021. All services performed on and after Oct. 1, 2021, must be reported with J1448.

Prior authorization is required by the Medical Benefit Drug Prior Authorization program for Cosela (trilaciclib dihydrochloride), procedure code J1448, for all groups unless they opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this procedure requires manual review.

J9247 replaces J3490, J3590 and C9080 when billing for Pepaxto (melphalan flufenamide)

Effective Oct. 1, 2021, CMS has established a permanent procedure code for specialty medical drug Pepaxto^® (melphalan flufenamide).

Services can continue to be reported with J3490, J3590 and C9080 through Sept. 30, 2021. All services performed on and after Oct. 1, 2021, must be reported with J9247.

Prior authorization is required through the AIM Oncology Management Authorization program for Pepaxto (melphalan flufenamide), procedure code J9247, for all groups unless are opted out of the prior authorization program.

Pepaxto (melphalan flufenamide) is covered for all groups not included in the AIM Oncology Management Authorization program as a chemotherapy benefit for malignant conditions.

J9318 replaces J3490, J3590 and C9065 when billing for romidepsin, non-lyophilized

Effective Oct. 1, 2021, CMS has established a permanent procedure code for specialty medical drug romidepsin, non-lyophilized.

Services can continue to be reported with J3490, J3590 and C9065 through September 30, 2021. All services performed on and after Oct. 1, 2021, must be reported with J9318.

Prior authorization is required through the AIM Oncology Management Authorization program for romidepsin, non-lyophilized, procedure code J9318, for all groups unless they opted out of the prior authorization program.

Romidepsin, non-lyophilized is covered for all groups not included in the AIM Oncology Management Authorization program as a chemotherapy benefit for malignant conditions.

Q2054 replaces J3490, J3590, J9999 and C9076 when billing for Breyanzi (lisocabtagene maraleucel)

Effective Oct. 1, 2021, CMS has established a permanent procedure code for specialty medical drug Breyanzi^® (lisocabtagene maraleucel).

Services can continue to be reported with J3490, J3590, J9999 and C9076 through Sept. 30, 2021. All services performed on and after Oct. 1, 2021, must be reported with Q2054.

Prior authorization is still required by the Medical Benefit Drug Prior Authorization program for Breyanzi (lisocabtagene maraleucel), procedure code Q2054, for all groups unless they opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this procedure requires manual review.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.